Psychosocial Problems of Old Age

Demographic Trend

The phenomenon, called population ageing, is a dynamic demographic trend all over the world. In 2015, one in eight people worldwide was aged 60 years or over. According to data from World Population Prospects (United Nations, 2015), the number of older persons, aged 60 years and above, has increased substantially in recent years in most countries and regions. Between 2015 and 2030, the number of people in the world aged 60 years or over is projected to grow by 56 per cent, from the present 901 million to 1.4 billion. Globally, during 2010-2015, women outlived men by an average of 4.5 years. As a result, women accounted for 54 per cent of the global population aged 60 years or over. According to Population Census 2011 (Elderly in India, 2016, Central Statistics Office, Ministry of Statistics and Programme Implementation, Government of India), there are nearly 104 million elderly persons in India,  53 million females and 51 million males. Both the share and size of elderly population in India has  increased over time from 5.6% in 1961 to 8.6% in 2011. These figures clearly indicate that  globally, the number of older persons is growing faster than the numbers of people in any other age group.

The increase of ageing population is directly associated with economic and social development,  advancements in public health and medical technologies, and improvements in living conditions.  Therefore, people are living longer and, in many cases, lives healthier than ever before, particularly at advanced ages.   Consequently, the increasing share of older persons in the population is becoming one of the most significant concerns of the modern society with increased demand for housing, food, protection, health care, services  and family ties. 

Changing Values

In modern period, the “cultural status” of old people has declined in many societies. Elders are seen no longer as bearers of wisdom but as an inescapable burden.  This attitude is directly associated with the impact of changing forces like rapid urbanization, industrialization, Westernization, changed roles of women, and breakdown of traditional family structures and roles. In fact, our society is moving away from the mutuality of familial and communitarian concepts to more individualistic and self-centred social vacuums. To some measure, the traditional intergenerational family ties cherished by the Indian culture is disappearing. All these changing trends have a direct bearing on our attitudes and responses to the elderly population. Unfortunately, thus, every now and then we hear reports of elderly parents are being abused, dispossessed, tortured, abandoned or dumped in old age homes, and finally a good number of this population dying in isolation and ignominy. Although a law was enacted by the Indian Parliament on  the Maintenance and Welfare of Parents and Senior Citizens Act which punishes children who abandon parents with a prison term of three months or a fine, the situation is grim for elderly people in India. Hence, the elderly population being marginalized go through extreme forms of mental agony and social isolation.   

The Concept of Ageing

Old age is the last stage of life, when physical strength deteriorates, mental ability weakens, the individual becomes economically dependent and sometimes, emotionally disturbed. These changes are natural accompaniments of what is known as “aging”. Old age is in fact, a period of decline in life cycle.  While most of the early stages of life is characterised by changes that are evolutional, in that they lead to maturity of structure and functioning, old age is mainly involutional, involving a regression to earlier stages (Hurlock, Developmental psychology).  But the  fact is ageing is a part of human finitude and a living process. 

Ageing has been studied from various perspectives such as the biological, psychological and sociological. Biological perspective regards ageing as a progressive loss of functional capacity of the person who has reached certain level of maturity. They affect physical as well as mental structures and functioning. Psychological ageing refers to personality changes taking place as a result of biological ageing.  Psychological decline may be due to unfavourable attitudes toward oneself, other people, work and life in general, may lead to senility, mentally less acute.  Sociological ageing indicates the changes in the roles, and status in relation to one’s family and communities around.  But it must also be recognized that the process of ageing involves an interaction of these various elements.  

Psychosocial Concerns

a) Adjustment Problems: Old age is confronted with various kinds of adjustment problems due to the physical,  psychological and social changes.    During this stage, a good number of persons retire from their jobs held for years.  Retirement from service not only dislocates them but also usually results in loss of a good income.  With the reduced income, they are reversed from the state of chief bread winner to a mere dependent, though they have spend their earnings on education of children, their marriage, acquiring new property, and family maintenance. In addition to the financial constraints they also discover that their duties as parents is coming to a close since children have completed their education and are employed mostly in places far away from the home town. As a result of these changes, their input is no longer requested or required.  All these isolate them from their family members, familiar friends and co-workers, negatively impacting their sense of identity and worth. 

b) Physical Well-Being: Physical wellbeing has significant influence on one’s attitude, identity, and relationships. Most of this population have difficulty to accept the reality of ageing process once they begin to notice signs of old age like grey hair, wrinkles, blood pressure variations, declining eye sight and hearing ability, decreasing sexual desire etc.  Osteoporosis affects millions of women bringing pain and restricted movements and shrivelling of spine. Some older people will protest and say that old age only starts when you feel old.  So they may say “age does not depend upon years but upon temperament.” Some tend to slow down ageing by extravagant use of vitamins, sex hormone therapy and undergoing cosmetic surgeries to cover up the signs of ageing. A large number of old people tend to deny their age by dressing like young people, by becoming adventurous, and engaging  in more physical activities. This attitude is an effect of our youth-worshipping culture, which compels old people avoiding any acknowledgement of their growing age. But the fact is that there is a progressive deterioration of health. Constant health problems like diabetics, arthritis, hypertension, breast cancer, heart ailments and repeated hospitalisation produce a sense of despair and hopelessness among this population. Failing health may lead to decreased mobility, and increasing dependency.   Deterioration of health in this population produces anxiety and fear.  The physical changes can influence a person’s self-esteem and sense of security With no adequate support and care, old age persons may experience emotional breakdown. 

c) Declining Mental Ability: Ageing may result in reduced mental and cognitive ability. There could be decline in mental ability, such as decreased speed in information processing, and slowing down of learning new things. It is well known that older persons take longer to respond, think more slowly, are less able to understand new ideas or develop new skills.  Memory loss is common in old age.  Dementia, the loss of memory and other intellectual abilities, seriously interfere with daily life. They develop symptoms like poor memory, intolerance of change, disorientation, restlessness, insomnia, failure of judgment, a gradual formation of delusions and hallucinations, extreme-mental depression and agitation, severe mental clouding in which the individual becomes restless, combative, resistive and incoherent. Dementia may also be manifested in strange behaviors like wandering, physical aggression, verbal outbursts, depression, and psychosis. Few develop Alzheimer’s disease which involves damage of nerve cells in the areas of the brain that control memory and other mental capabilities. It has been observed that dementia and Alzheimer’s disease account for approximately 80% of the psychotic disorders among older people in the civilized societies. The cognitive defects due to dementia and Alzheimer’s disease seriously interferes with normal functioning of a person in mental capacities, emotional balance and interpersonal relationships. 

d) Mental health Problems: Other than these mental deficits, some old aged persons develop other mental health problems.  Studies by the World Health Organization estimates that mental disorders afflict about 15% of people aged above 60 years. Older people are susceptible to psychotic depressions. Some of them develop problems like depression, with a sense of hopelessness and worthlessness, others show signs of paranoia characterized by suspiciousness and distrust in others, and hypochondria in which the individual is preoccupied with fears of fatal illnesses.  Decline in mental ability make them dependent. They no longer have trust in their own ability or judgments though they want to control the younger ones. They want to get involved in all family matters and business issues. Due to generation gap the youngsters may not pay attention to their suggestion and advice. Instead of developing a sympathetic attitude towards the old, they start asserting their rights and power. This may create a feeling of deprivation of their dignity and importance.

e) Death Anxieties: For many death, the terminus of life become a topic of worry. As people grow older, they usually become less interested in life after death but rather more concerned about death itself.  This is especially true of elderly people whose physical or mental condition has begun to deteriorate.  For some there is a fear of death itself and painful uncertainty about the existence or non-existence of life after death. When health fails they tend to concentrate on death and become preoccupied with it.  Almost all elderly ask at least five questions to themselves or others: “When will I die? What is likely to cause my death? What can I do to die as I wish to die? Am I justified in taking my life, if life becomes unbearable” How can I have a good death” The fact is that everyone wants to preserve dignity in death and have a sense of control even when the inevitable invades life. Loss of spouse during old age is another hazard. Death of a spouse creates a feeling of loneliness and isolation. Witnessing the death of close friends and relative sometimes send waves of shock in the elderly, silently reminding one’s own vulnerability. A person may become anxious about one’s own death and the life of spouse and children who were dependent on them.  One’s vulnerability to sicknesses and the impending death are topics of constant worry among this population.  

f) Social Adjustments: Older people also suffer social losses greatly with age. Retirement isolates them from the occupational world.  Due to loss of most of the social roles they once performed, they are likely to be lonely and isolated.  Their social life is narrowed down by loss of work associates, death of relatives, friends and spouse.  Weak health may restrict their participation in social activities. Declining health also limits one’s mobility.  The home becomes the centre of their social life which gets confined to the interpersonal relationship with the family members. Children are also unable to extend necessary social contact on account of their studies or employment.  The negligent and indifferent attitude of the family members towards the older people further creates more emotional problems.  Children may abuse them physically or emotionally, or abandon them though they are too weak to defend.  All these may contribute to the older person’s withdrawal from social contacts.  He may feel that he is no longer useful or needed.  It is noteworthy that studies have shown that older people who have one or more close friends, or intimate relationships seem to be happier, better adjusted and in better health than those without such confidents.  In fact, older people who withdraw from others may end up with premature death. 

g) Coping with old Age: Everyone in this stage of life has to come to terms with their life  and thereby coming to terms with the end of life.  Erik Erikson who advocated eight stages of life points out that old age is a period of during which a person focuses on reflecting back on his life. Those who feel proud of their accomplishments will feel a sense of integrity. Completing this phase for them means looking back with few regrets and a general feeling of satisfaction. If someone is able to look back and accept the course of events, the choices made, the life as lived it, as being necessary, then that individual need not fear death.  These individuals will attain wisdom, even when confronting death. Those who are unsuccessful during this phase will feel that their life has been wasted and will experience many regrets. The individual will be left with feelings of bitterness and despair. Some become preoccupied with their failures, the bad decisions they made, and regret that they really don't have the time or energy to reverse them.  They may experience despair as suggested by Erikson.  

Responding to the Elderly

The Bible clearly places the duty to parents as mandatory on children.  In the Ten Commandments, God commands” “Honour your father and your mother, that your days may be  long in the land that  the Lord your  God is giving you” (Ex. 20:12).  This command is reiterated in the Old Testament Law by Moses and in the gospels by Jesus Christ (Lev. 19:3; Matt. 15:4; 19:19; Mark 7:10; 10:19; Luke 18:20).  Paul in his teachings regarded it sacred duty as he further commands that “this is the first commandment with a promise” (Eph:6:2).  In Biblical times it was recognised wisdom increased with age (Job :12:12): “Wisdom is with the aged, and understanding in length of days.” However still Psalmist prayed “forsake me not, O God, when I am old and grey” (Psalm 71:18). Ecclesiastes 12 gives clear description of old age, so that wisdom will be applied during one’s life time before he returns to eternal home. All these scriptures give us directions on not only honouring the parents but also caring for the elderly during their periods of declining health. 

In the Indian traditional society, respecting elderly and caring for them was regarded as a sacred duty, which would in turn determine their fortunes. Disregarding parents by children was faced with condemnation of the families and society.  According to a laws passed by the Indian Parliament, parents cannot be evicted from a house without due process of law if they have been staying there from before. There are three enactments that can be applied. 

Under section 125 of the Cr. PC, a magistrate can order a child to maintain his old parents under the Maintenance of Parents Act.

The Hindu Adoptions and Maintenance Act say an aged parent can demand maintenance from children in the same way that a wife can demand it from her husband.

The Domestic Violence Act too provides parents with the right to seek relief from any kind of abuse.

Hence, addressing the needs and concerns of the aged population must be the primary focus of the family, health workers, and churches. Care and support will produce and sense of worth and will enable them to face the inevitable of human existence. Spiritual wellbeing enables them to face the inevitably questions of forgiveness for failures, fear of judgement, meaninglessness in life and questions of death. Religion can promote a positive outlook among the elderly by encouraging them to participate in  community affairs, inviting them to share their experiences etc. Help them to uphold the validity and dignity of life.